Natural history of asymptomatic extracranial arterial disease: results of a long-term prospective study

The natural history of asymptomatic extracranial arterial disease (EAD) was studied prospectively in 339 patients admitted for serial ultrasound Doppler examinations. Annual mortality was high at 7%, but stroke mortality was low at 0.6%: 82 patients (24%) died during the follow-up period, which last...

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Bibliographic Details
Published in:Brain (London, England : 1878) England : 1878), 1987-06, Vol.110 (3), p.777-791
Main Authors: HENNERICH, M, HÜLSBÖMER, H.-B, HEFTER, H, LAMMERTS, D, RAUTENBERG, W
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Arteriosclerosis - complications
Arteriosclerosis - diagnosis
Arteriosclerosis - mortality
Biological and medical sciences
Carotid Artery Diseases - complications
Carotid Artery Diseases - diagnosis
Carotid Artery Diseases - mortality
Cerebrovascular Disorders - etiology
Cerebrovascular Disorders - mortality
Endarterectomy
Female
Humans
Ischemic Attack, Transient - etiology
Male
Medical sciences
Middle Aged
Neurology
Prospective Studies
Ultrasonics
Vascular diseases and vascular malformations of the nervous system
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Summary:The natural history of asymptomatic extracranial arterial disease (EAD) was studied prospectively in 339 patients admitted for serial ultrasound Doppler examinations. Annual mortality was high at 7%, but stroke mortality was low at 0.6%: 82 patients (24%) died during the follow-up period, which lasted up to seven years (median: 29 months), only 10 from stroke but 41 from cardiac causes. The risk of suffering a stroke without premonitory transient ischaemic attacks (TIAs) was similarly low at 0.4%. Progression of EAD was the only predictor established to indicate the individual patient's cerebrovascular prognosis among a series of criteria tested (age, sex, degree and extent of carotid and/or vertebral disease, risk factors and indicators of atherosclerosis). Deterioration of EAD was observed in 108 (36%) of 296 patients by repeated Doppler examination, 174 (59%) remained constant and 14 (5%) showed an improvement. The observed low rate of strokes without premonitory TIAs is not in favour for early carotid endarterectomy in the majority of neurologically asymptomatic patients.
ISSN:0006-8950
1460-2156
DOI:10.1093/brain/110.3.777